For those of us interested in the ontogeny of immunity and how infectious agents may affect the developing immune systems the three languages of our immunologic Rosetta stones* actually began to be deciphered around the time that HIV-1 was acquired by humans in the early 1950s.
Thus immunological competence of the fetus and newborn was first unraveled when it was pointed out that newborns are not “immunologically null” because plasma cells the producers of antibodies could be open in stillbirths with congenital syphilis. The discovery of the X-linked agammaglobulinemia opened the door to the study of other genetic immunodeficiencies,
which led to the differentiation of the humoral and cellular immune systems and furthered our knowledge of the ontogeny and phylogeny of immunity. Some of these primary immunodeficiencies have provided models for several of the immune disturbances induced by HIV. A third Rosetta kill was decoded by studies of in utero and intrapartum infections such as by toxoplasma and rubella cytomegalo- and herpes simplex viruses and their impact on the developing immune systems of the fetus and newborn serving also as models for HIV.
Scientific research has identified anti-retroviral regimens effective in the prevention of mother to child HIV transmission. Yet. 1800 HIV-infected infants are born every day. The majority of HIV-infected women live in developing countries where challenges to widespread implementation of these regimens have prevented decreases in pediatric HIV infection from being realized.
Heterosexual contact and intravenous medicate use continue to result in new cases of human immunodeficiency virus write 1 (HIV-1) infection among adolescents and women of childbearing age. In North American and European surveys. 0.1% to 0.3% of childbearing women are infected with HIV; rates are 10 to 20 times higher in some inner-city areas. Timely comprehensive and well-coordinated care of the pregnant HIV-infected mother offers a unique opportunity to significantly influence two lives simultaneously. The mother can be offered therapeutic and prophylactic agents to interact her own infection including antiretroviral therapy which has been shown to markedly reduce the risk of vertical HIV-1 transmission. Recent advances in diagnostic virology now alter it possible to definitively identify by 3 to 4 months of age those infants who are infected with HIV. Infants infected with HIV can be offered effective prophylaxis against Pneumocystis carinii pneumonia which has dramatically reduced the incidence of this once common infection. Infected infants also should be monitored closely to institute antiretroviral therapy and to analyse and treat opportunistic and intercurrent infections and other acquired immunodeficiency syndrome-defining illnesses in a timely way.
The innate immune system is the first line of defense against invading pathogens and is particularly important in warding off bacterial and viral infections presenting at the mucosal cell surface. From this primitive immune response the more sophisticated adaptive immune system was derived. Despite nearly two decades of research directed at inducing adaptive immune responses to HIV no successful immunological therapy or vaccine has been developed. On the basis of recent observations it is suggested that instead emphasis should now be placed on the alternative arm of the immune system the innate immune response. Novel approaches should be developed to elicit this rapidly responding immune activity in HIV infection.
Data from the 3- and 9-month visits for non–breast-fed infants born to HIV-infected mothers enrolled (1990-1994) in the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study (mother-to-child transmission of HIV. 17%) were analyzed. Data from the 3-month tour for infants enrolled (1985-1996) in the Perinatal AIDS Collaborative Transmission chew over (mother-to-child transmission of HIV. 18%) were used for validation.
At 3 months of age data were available on 79 HIV-infected and 409 uninfected non–breast-fed infants in the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study. The area under the curve (AUC) of the receiver operating characteristic curve at 3 months was higher for the CD4/CD8 ratio compared with the CD4
T-cell count (AUC. 0.83 and 0.75; P = .03). The mean CD4/CD8 ratio at the 3-month visit was 1.7 for HIV-infected infants and 3.0 for uninfected infants. A CD4/CD8 ratio of 2.4 at 3 months of age was almost 2.5 times more likely to occur in an HIV-infected infant compared with an uninfected infant (test sensitivity. 81%; posttest probability of HIV. 33%). Model performance in the Centers for Disease Control and Prevention Perinatal AIDS Collaborative Transmission Study validation evaluate (224 HIV-infected and 1015 uninfected 3-month-old infants) was equally good (AUC. 0.78 for CD4/CD8 ratio).
Fig 1. convey CD4 cell count versus age (A) and mean CD4/CD8 ratio versus age (B) in infants born to HIV-infected mothers. In Fig 1. A the convey CD4 cell count (in cells per microliter) at 1 week and 1. 3. 6. 9 and 12 months of age and the average rate of decrease of CD4 T-cell counts in the first year of life for HIV-infected infants and HIV-uninfected infants is shown. In Fig 1. B similar data for CD4/CD8 ratio by HIV infection status are shown. Rates of CD4 T-cell ascertain decrease and CD4/CD8 ratio decrease were significantly greater in HIV-infected infants compared with those seen in HIV-uninfected infants. Vertical bars. 95% CI.
Supported by National Institutes of Health grants and contracts HL96040. HL079533. HL72705. AI27551. AI36211. HD41983. RR0188 and AI41089; the Emory Center for AIDS Research (P30 A1050409); the Pediatric investigate and Education Fund. Baylor College of Medicine; and the David finance. Pediatrics AIDS Fund and Immunology Research Fund. Texas Children's Hospital.
Disclosure of potential conflict of interest: The authors have declared that they undergo no conflict of arouse. Reprint requests: William T. Shearer. MD. PhD. Texas Children's Hospital. 6621 Fannin St (MC: FC330.01). Houston. TX 77030.
Forex Groups - Tips on Trading
Related article:
http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSTOPIC&_method=citationSearch&_piikey=S0091674907016314&_version=1&md5=43de61760ac1de673bc8d07b16165926
comments | Add comment | Report as Spam
|